Louisiana STD prevention spending lowest since 2011

Carolyn Priddy, a nurse at the Caddo Parish Health Unit, prepares a urine sample for STD testing. Federal STD prevention expenditures in Louisiana is the highest this year that it’s been since 2012.(Photo: Adam Duvernay/Gannett Louisiana)

Public health budgets nationwide are affecting how and with whom Americans have sex.

Across-the-board cutbacks are threatening efforts to stem sexually transmitted infection rates, but Louisiana health officials say there's more to solving the problem than throwing dollars at it. The state is working to expand access to screening and treatment at the same time its spending on prevention decreases.

"Health doesn't just take place in a clinic. It should be what we live," said Louisiana Department of Health and Hospitals Assistant Secretary for Public Health J.T Lane.

STD prevention expenditures in the Louisiana Department of Health and Hospitals budget are at their lowest levels since at least 2011 while federal funding for the same costs are the highest they've been since 2012.No

Total prevention expenditures decreased by nearly $2.4 million — decreasing from $11 million to $8.6 million — between 2011 and 2014.

Federal dollars have gone from $2.5 million in 2011 to $3.4 million this year, an increase of more than $900,000. State spending decreased from $7.1 million in 2011 to $4.6 million this year — a $2.5 million cut.

Revenues collected from Medicade billings, co-pays and private insurance spent on STD prevention in Louisiana also decreased from $1.3 million in 2011 to $621,245 this year. The lowest spending of these dollars in those years was $535,960 spent in 2013.

Louisiana in 2012 had the country's highest rate of infection for congenital syphilis, the second highest for gonorrhea, the third highest for primary and secondary syphilis and the fourth highest for chlamydia. Caddo ranked fourth in the nation for syphilis, and the parish was near the top for all other kinds of sexual infections in the state.

Louisiana in 2013 received about $2.2 million from the Centers for Disease Control and Prevention for non-HIV/AIDS STD prevention, the largest single portion of which — 11.4 percent — was spent in northwestern Louisiana. The New Orleans area received the second largest slice at 11 percent.

The distribution of those federal funds is based on per capita need, Lane said, with resources deployed where they're most needed.

The Caddo Parish Health Unit, whose staff screens patients and facilitates testing, added a third nurse to its roster last year, Lane said. The clinic performed an average of 19 tests for gonorrhea and chlamydia and 22 for syphilis each day last year, he said.

But while they cannot afford to simply over staff each of the state's clinics to combat the epidemic, Lane said there's been an effort to include family planning nurses in the screening and testing process through advanced training. The state has also been reaching out to and partnering with community and religious leaders to promote healthy sexual activity and regular testing.

Men in Louisiana who live at up to 133 percent of the poverty line are now also covered for testing and prevention through Medicade, Lane said. It's only been a short time since that change took effect, and Lane said DHH will be watching over the next six to 12 months to see how well it helps slow the infection rate.

"In Louisiana, we've done a good job covering women and children, but men, not so much," Lane said. "By doing that we'll better prevent the spread of infection."

DHH also has deployed specialists across the state — especially in northwestern Louisiana and New Orleans — to work in the field reaching out to the community and making contact with patients with positive test results and helping track down those they've had sexual contact with to encourage screening.

But, at the federal and state level, funding remains unsatisfactory, according to the National Coalition of STD Directors.

"We can say the nation's public health infrastructure is paper-thin because of cutbacks on every level," said NCSD Executive Director Bill Smith. "Public health is always on the chopping block. This is what happens when politicians make poor decisions. Public health cannot withstand further cuts."

The 2015 presidential budget for the CDC's Division of STD Prevention remained static from this year to next at $157 million, an increase of about $3 million from 2013 but down about $6 million from 2012. NCSD recommends allocating another $53 million to the 2015 budget to meet the nation's health needs.

At the federal level, Smith indicated the discussion on sexual health at least is headed in the right direction — he said hang-ups about sexuality, morality and religion have not presented serious roadblocks to funding.

"There are the controversial discussions — sexual education, abortion — that are always electrified. At the federal level though, there is a recognition the problem is not as volatile as those," Smith said. "It's much less susceptible to political shenanigans."

More pressing is a simple fact in America — we're broke.

Nearly 70 percent of STD programs nationwide experienced funding cuts in 2008-09, including half receiving cuts in state and local support and 56 percent seeing federal cuts, according to the NCSD. Those cuts encompassed salary freezes and reductions, furlough and government shutdown days and layoffs in 27 percent of the nation's programs.

Nearly 40 clinics closed their doors in that time frame, capping a decade-long closure trend which reduced the country's active clinics by 10 percent.

Despite Louisiana's high ranking in national infection rates, the state didn't fall down when it came to funding in 2009 and provided the nation's highest per capital spending on STD prevention at $1.57 when the national average was 16 cents, according to the American Social Health Association.

By the numbers

Department of Health and Hospitals/ Office of Public Health STD prevention expenditures